Exchange considering ways to improve doctor directories

Bel Air, MD -- Ivan Mejia, a bilingual navigator for Seedco, sets up banners at an informational event about options for health coverage on the Maryland Health Exchange, which was held Nov. 1 at the Abingdon branch of the Harford county public library. (Barbara Haddock Taylor / Baltimore Sun)

The board that oversees Maryland's online health insurance marketplace is considering several ways to improve the accuracy of its doctor directories, but consumers might not see major changes for another two years.

Advocacy groups for mental health and maternity care have criticized the Maryland Health Benefit Exchange this year for its outdated directories.

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The remedies being considered by the exchange include requiring insurance companies, which provide the doctor lists to the state, to come up with a plan to improve the directories. They also are looking at creating a way to allow consumers to report inaccuracies, which then could be passed on to the carriers, a method that has worked for the District of Columbia exchange.

The strategies, presented to the board Monday by the health exchange's policy director, were based on recommendations from a work group formed this year after a report by the Mental Health Association of Maryland found that only 14 percent of the 1,154 psychiatrists listed in exchange directories were accepting new patients and available for appointments within 45 days.

A more recent report released last week by the Maryland Women's Coalition for Health Care Reform found the online directory of obstetrician-gynecologists so outdated that only about 22 percent of the 1,493 practitioners were accepting new patients, performed well-patient visits and had appointments available within four weeks.

More than a third of OB-GYNs weren't available at all because they had left the networks, retired or died — including Nikita Levy, the former Johns Hopkins gynecologist who killed himself in 2013 after police opened an investigation into allegations he had taken pictures and videos of his patients during pelvic exams.

Inaccurate directories also can lead to consumers unknowingly choosing more expensive out-of-network doctors, advocates say.

Leni Preston, who chairs the women's health coalition, commended the exchange board for trying to address the problems with the directories but said too much of the responsibility is being put on consumers and questioned whether the insurers should be policing themselves.

"I think we need to be watchful of what the carriers are going to be doing in this regard — and hold their feet to the fire," Preston said.

CareFirst BlueCross BlueShield, the state's dominant insurer, did not respond to requests for comment. Company officials have said in the past that they rely on doctors to provide them with the most current information. The insurer said it requires doctors in their networks to verify and update their information at least twice a year and has sent letters, postcards, emails and made phone calls to encourage participation.

Insurance commissioner Al Redmer Jr., who sits on the exchange board, said it is up to the insurance companies to get accurate information from doctors and other providers.

"There has to be accountability for providing an accurate directory, no matter how they do it," Redmer said.

The requirements for provider directories are part of the certification process insurance companies must undergo each year to be listed on the exchange. The exchange wants to work with insurers to correct the problem rather than take away certification, said Carolyn Quattrocki, executive director of the exchange.

"You don't want to use the nuclear option right away," Quattrocki said.

The recommendations presented to the board also include requiring insurers to provide the directory information on their website without requiring a login. Insurance companies also would have to provide the exchange with data on the average wait time for primary care physicians and mental health providers and whether primary care doctors and mental health professionals were accepting new patients.

If the board accepts the recommendations, which could happen at a future meeting, insurance companies would have to provide their plans as part of their certification process for 2017 and they would take effect the next year.